Key Tool for Stratifying Patients for Home Visits

Thursday, May 29th, 2014
This post was written by Cheryl Miller

Tools like the Hospital Admission Risk Monitoring Systems (HARMS) 8 and 11 help to identify patients that would most benefit from a home visit, particularly critical as case loads and time demands grow, says Samantha Valcourt, MS, RN, CNS, clinical nurse specialist for Stanford Coordinated Care, a part of Stanford Hospital and Clinic.

One of the key things to think about when implementing a home visit program is which patients should receive the visits. Who is at risk for having adverse events after hospital discharge, and how do we identify those patients? Just as there are many care transition models, there are many tools that exist to help to risk-stratify those at high risk. Some of them focus on certain conditions, including myocardial infarction (MI), heart failure (HF) and pneumonia (PNA). There are even iPhone apps, into which you can plug certain criteria, like a patient’s age, and whether they have they been to the emergency room (ER). They all try to predict if the patient is at high risk for readmission.

At Stanford Coordinated Care (SCC) we use a tool called the HARMS-11. It’s a modified version of the HARMS-8, a tool created by David Labby and Rebecca Ramsay at Care Oregon. It’s an admission risk monitoring system; it stands for Hospital Admission Risk Monitoring Systems. The numbers 8 and 11 refer to how many questions are on the tool or how many items there are to answer.

We use this tool in two ways: it helps me to identify patients that may need a home visit, and it also helps us to see if a patient is eligible to receive services in our clinic. Besides being a clinic for employees of the hospital and university, we focus on those employees that have chronic or complex health conditions. This tool helps us get a sense of whether they are struggling with many conditions, and what their social support is like. How many medications do they take in a day? Do they ever forget to take them or simply choose not to take them?

The HARMS is written so that the patient can take it as a self-assessment. Positive answers to these questions give us a good indication that this patient may be a good one to see at home after hospitalization. Given that all of our patients have to have multiple conditions, there’s very few that I try not to see after discharge. But as our case load continues to grow and time demands other things, we’re going to make some decisions on who we see. We’re going to go back to this tool to help us do that.

Excerpted from: Home Visits for High-Risk Patients: Tools, Timing and Outcomes.

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